Anyone had dealings with MAMSI?

I have mamsi optimum choice ppo and would like any information and or advice when dealing with this insurance company. If anyone out there has more advice.. please email me at [email protected] Thanks so much! Joel

Hi Joel- I work for Dr. Afram and Dr. Buras in DC. I do all of the approvals. Dealing with MAMSI/OPT CHOICE can be really easy these days. They have chosen doctors, that if you go to them you do not have to do the things they typically require. They basically chose these doctors by the program that they have and success rates.... BUT your policy still has to cover it. It is only easy if you have the benefit. That means, by going to one of them, the doctors office will get your authorization fast with no problem. Dr. Buras is an in network provider who was chosen by MAMSI. I fax the request to MAMSI the day the patient comes in and get the auth within 48 hours. Easy as that.... much easier than it used to be. Hope this helps Mandy

Joel, I too had my surgery when I was with Mamsi-Otimum choice. I had a 6 month required physicians supervised diet then I met with the surgeon and the office called me back the next week with approval and I had surgery 3 weeks later. Mamsi told them that my insurance was changing and that I needed to have it by April 30th. They were fantastic at getting the approval through and their support when the bills started coming in, even after I was no longer their client. I made sure that I went for my monthly weigh ins and actually scheduled them from my initial visit with the physician. I will be away this weekend but feel free to email me any questions you have. But for the first time since I got Mamsi 3 years ago, I really felt good about my insurance. BTW Mamsi gave my surgeons office the center for excellence this year so that could help you if you haven't found a surgeons office yet too. Have a great weekend. Denise

My husband could get optimum choice but since his employer has a small business policy, WLS is excluded. WLS is only covered for small businesses if they purchase a rider to the policy which means more money for the employer so almost all S/B policies will exclude.

Joel, If weight loss surgery is covered by your plan, I think the pearls of wisdom shared by Mandy and Denise are good news for you, and consistent with what I've heard about the company. If WLS is specifically excluded, such as my employer's plan with MD-IPA, a MAMSI subsidiary, you could be on your death bed with WLS as the only salvation, and they'd help you plan your funeral (maybe). I work in Washington, DC for a private firm, and our health plan is considered a contract under DC law, regardless of the fact that I live in Maryland, use Maryland doctors, and pay my taxes to the State of Maryland. I went through their full appeal structure, presented significant evidence of the benefits of WLS, particularly since my BMI was in the high 50s and I had co-morbidities (including Type 2 diabetes and high blood pressure). They stuck with their denial and I was self-pay. Today, they are reaping the benefits of my weight loss, along with the loss of my co-morbidities and the lowered cost to them for my health care. Good luck. Leesa